2004, 07-20 Permit App: BLD-04-07111 Plumbing Reversal Sn,' ��►A,lly�ss����pp PLUMBING PERMIT APPLICATION
• City of Spokane Valley Community Development Department
BuildingDivision
�� 5 ic-,...,A 911707 E. Sprague Avenue, Suite 106
4„,,,Val\' 1Iey / Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address:
Cv 3 0?6, Z 6 4 Permit Use:
Owner: /e, , hi 5.1 Ark.sPhone (Daytime Contact): J 3y-.724)
Mailing Address: ,-Cs/ rr `e_
City State Zip Code
Contractor: ( Lfrl�e,,,j 640 �iti. License#:t ,,/',-e- /1'60?? Phone#: ,yam 9.W5(-- s5
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6.00 =
2 URINALS X $6.00
3 TUBS -X $6.00
4 SHOWERS(PER TRAP) BATH,STALL ON-SITE BUILT X $6.00 =
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 =
CONDENSATE ,
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, / X $6.00 = ,.E
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
METHOD OF PAYMENT: SUBTOTAL C,v, co
DATCASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
: EXPIRES: TOTAL PERMIT FEE DUE: V/,CO
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: